This review, commissioned by the Research Councils UK Living With Environmental Change (LWEC) programme, concerns research on the impacts on health and social care systems in the United Kingdom of extreme weather events, under conditions of climate change. Extreme weather events considered include heatwaves, coldwaves and flooding. Using a structured review method, we consider evidence regarding the currently observed and anticipated future impacts of extreme weather on health and social care systems and the potential of preparedness and adaptation measures that may enhance resilience. We highlight a number of general conclusions which are likely to be of international relevance, although the review focussed on the situation in the UK. Extreme weather events impact the operation of health services through the effects on built, social and institutional infrastructures which support health and health care, and also because of changes in service demand as extreme weather impacts on human health. Strategic planning for extreme weather and impacts on the care system should be sensitive to within country variations. Adaptation will require changes to built infrastructure systems (including transport and utilities as well as individual care facilities) and also to institutional and social infrastructure supporting the health care system. Care sector organisations, communities and individuals need to adapt their practices to improve resilience of health and health care to extreme weather. Preparedness and emergency response strategies call for action extending beyond the emergency response services, to include health and social care providers more generally.Electronic supplementary materialThe online version of this article (10.1186/s12940-017-0324-3) contains supplementary material, which is available to authorized users.

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This study explores why progress with tackling health inequalities has varied among a group of local authority areas in England that were set targets to narrow important health outcomes compared to national averages. It focuses on premature deaths from cancers and cardiovascular disease (CVD) and whether the local authority gap for these outcomes narrowed. Survey and secondary data were used to create dichotomised conditions describing each area. For cancers, ten conditions were found to be associated with whether or not narrowing occurred: presence/absence of a working culture of individual commitment and champions; spending on cancer programmes; aspirational or comfortable/complacent organisational cultures; deprivation; crime; assessments of strategic partnership working, commissioning and the public health workforce; frequency of progress reviews; and performance rating of the local Primary Care Trust (PCT). For CVD, six conditions were associated with whether or not narrowing occurred: a PCT budget closer or further away from target; assessments of primary care services, smoking cessation services and local leadership; presence/absence of a few major programmes; and population turnover. The method of Qualitative Comparative Analysis was used to find configurations of these conditions with either the narrowing or not narrowing outcomes. Narrowing cancer gaps were associated with three configurations in which individual commitment and champions was a necessary condition, and not narrowing was associated with a group of conditions that had in common a high level of bureaucratic-type work. Narrowing CVD gaps were associated with three configurations in which a high assessment of either primary care or smoking cessation services was a necessary condition, and not narrowing was associated with two configurations that both included an absence of major programmes. The article considers substantive and theoretical arguments for these configurations being causal and as pointing to ways of improving progress with tackling health inequalities.

The QCA identified potential causal pathways for health improvement from the intervention with important potential implications for health inequalities. QCA should be considered as a viable and practical method in the public health evaluation tool box.

Too often, members of the working class who voted to leave the European Union in the 2016 referendum have been framed as uneducated and unaware of their own economic interests. This article, based on 26 in-depth face-to-face interviews and a further telephone interview on Teesside in the North East of England, offers an alternative perspective that is more nuanced and less reductionist. The article critiques some of the commonly heard tropes regarding the rationale for voting leave, it then exposes how leave voters rooted their decision in a localised experience of neoliberalism’s slow-motion social dislocation linked to the deindustrialisation of the area and the failure of political parties, particularly the Labour Party, to speak for regional or working-class interests.

This paper critically discusses the utility of using qualitative comparative analysis (QCA) in geographical research following the 'complexity turn'. Although QCA methodology has increasingly been applied in other social science disciplines, it is not widely used by geographers. The major benefit of QCA is that it can handle complexity by exploring different pathways that generate the same outcome, which applies to much spatial research. Significantly, QCA is caserather than variableoriented, which is hugely important when considering the significance of context. In this paper we illustrate how QCA can be applied in the discipline of geography through a case study of area-level health resilience. We argue that QCA can be usefully applied to such geographical questions as it aids our understanding of the complex processes that lead to spatial variations in health. Moreover, QCA enables geographical research to bridge the quantitative-qualitative divide. We conclude that QCA has great potential for exploring the complex, spatial factors that influence area-level health resilience by being context-sensitive and case-oriented. We make the case for applying this methodology in future geographical research.

This paper presents a Qualitative Comparative Analysis (QCA) analysis of data produced as part of the evaluation a Nation Health Service commissioned intervention in the North East of England. QCA is a case-oriented method that allows systematic comparison of cases as configurations of set memberships based on their attributes and the relationship of these to particular outcomes. QCA provides an alternative to conventional quantitative approaches which are generally concerned with isolating the independent effect of one variable whilst controlling the influence of others. Instead, QCA allows for interactions between multiple attributes and recognises that the same outcomes may be generated by different configurations of attributes. The intervention evaluated provided case management for individuals who were out of work due to ill health, and had been for three years or more. It aimed to improve the health of individuals and move them closer to the labour market. The intervention and a comparison group were assessed at base line (T1), after 3 months — (T2) after 6 months (end of the intervention — T3) and after 9 months (three months post intervention — T4). The size of the respective populations at each time point were, Intervention group at T1, N = 131, T2, N = 44, T3, N = 79, T4, N = 95. Comparison group at T1, N = 229, T2, N = 188, T3, N = 166, T4, N = 154. General health was measured using EQ5-D (a standardised instrument for use as a measure of general health outcome) and SF-8. Two condition specific measures were included: the Hospital Anxiety and Depression Scale (HADS) and the Nordic Musculoskeletal questionnaire. Data was also collected on socio demographics (gender, age, housing tenure), social capital (contact with family and friends and participation with the wider community), and work history (previous jobs, time spent in the job, time spent on sickness absence). The aim of the QCA analysis was to identify whether individuals with certain characteristics or combinations of characteristics benefited from the intervention. In order to do this the cases were sorted according to whether their EQ-5D VAS (Visual Analogue Scale) scores (a self rated measure of general health) narrowed or did not narrow towards the population norm for the measure between baseline (T1) and (T4) 9 months (three months post intervention — T4). Cases which narrowed towards the UK population norm of 82.48 were judged to be experiencing a health improvement whilst those whose scores did not narrow towards the norm were judged to not have experienced a health improvement. A crisp set (cs) QCA analysis was then performed. The paper assesses the benefits of using QCA, and asks whether it can provide a viable and practical tool for social policy evaluations.

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